講演情報
[AS2-3]Current Status of Intracorporeal Anastomosis in Colorectal Cancer Surgery
Mamoru Uemura, Mitsunobu Takeda, Yuki Sekido, Tsuyoshi Hata, Atsushi Hamabe, Takayuki Ogino, Norikatsu Miyoshi, Yuichiro Doki, Hidetoshi Eguchi (Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University)
【Background】
Intracorporeal anastomosis（IA）in colectomy speeds recovery by reducing gastrointestinal mobilization. With advances in surgical devices, IA is safer and more common in Japan. Techniques like overlap, delta-shaped, and functional end-to-end anastomosis have unique benefits. We primarily use the overlap method, along with delta-shaped. In colorectal cancer IA, the overlap method allows a wide anastomotic site on the mesenteric side, easing the procedure even in obese patients. However, it is complex and time-consuming due to suturing. To address this, we developed a sutureless method using an automatic suturing device. This presentation discusses the technique and outcomes.
【Methods】
This study included 73 patients undergoing IA from March 2021 to March 2024, excluding other trials. We used delta-shaped, standard overlap with hand-sewing, and sutureless overlap, refining techniques over time. In the sutureless method, small openings were made 2 cm from the small bowel stump and 8 cm from the colon stump, followed by side-to-side anastomosis with a 60mm cartridge. The insertion hole was closed using the same cartridge.
【Results】
The median age of 73 patients was 72 years；32 males and 41 females, with a median BMI of 22.9. Lesion locations were V/C/A/T/D：1/23/29/15/5, with stages I/II/III/IV：41/13/13/6 cases. Anastomosis methods were delta-shaped in 34 cases, standard overlap in 8, and sutureless overlap in 30. Median anastomosis times were 12/33.5/15 minutes, with standard overlap significantly longer（P＜0.001）. No significant difference was found between delta and sutureless methods（P=0.2262）. Median operative times and blood loss were 250/266/237 minutes and 10/15/0 ml. Grade III or higher complications included one ileus case in both delta and sutureless groups. The 12-month relapse-free survival（12M-RFS）was 95.8％ for delta, and 100％ for both standard and sutureless methods, with no peritoneal recurrences.
【Conclusion】
The sutureless overlap method shortens operative time with good oncological outcomes. Continued follow-up is necessary.
Intracorporeal anastomosis（IA）in colectomy speeds recovery by reducing gastrointestinal mobilization. With advances in surgical devices, IA is safer and more common in Japan. Techniques like overlap, delta-shaped, and functional end-to-end anastomosis have unique benefits. We primarily use the overlap method, along with delta-shaped. In colorectal cancer IA, the overlap method allows a wide anastomotic site on the mesenteric side, easing the procedure even in obese patients. However, it is complex and time-consuming due to suturing. To address this, we developed a sutureless method using an automatic suturing device. This presentation discusses the technique and outcomes.
【Methods】
This study included 73 patients undergoing IA from March 2021 to March 2024, excluding other trials. We used delta-shaped, standard overlap with hand-sewing, and sutureless overlap, refining techniques over time. In the sutureless method, small openings were made 2 cm from the small bowel stump and 8 cm from the colon stump, followed by side-to-side anastomosis with a 60mm cartridge. The insertion hole was closed using the same cartridge.
【Results】
The median age of 73 patients was 72 years；32 males and 41 females, with a median BMI of 22.9. Lesion locations were V/C/A/T/D：1/23/29/15/5, with stages I/II/III/IV：41/13/13/6 cases. Anastomosis methods were delta-shaped in 34 cases, standard overlap in 8, and sutureless overlap in 30. Median anastomosis times were 12/33.5/15 minutes, with standard overlap significantly longer（P＜0.001）. No significant difference was found between delta and sutureless methods（P=0.2262）. Median operative times and blood loss were 250/266/237 minutes and 10/15/0 ml. Grade III or higher complications included one ileus case in both delta and sutureless groups. The 12-month relapse-free survival（12M-RFS）was 95.8％ for delta, and 100％ for both standard and sutureless methods, with no peritoneal recurrences.
【Conclusion】
The sutureless overlap method shortens operative time with good oncological outcomes. Continued follow-up is necessary.